Patient specific approaches based on new technologies to plan and to guide the
surgical act in plastic surgery, gynecologic surgery and orthopedic surgery
Paolo D. Parchi
(Ist Orthopedic Division Chief Prof Michele Lisanti)
1
Plastic
Surgery
Marcello Pantaloni
U.O.C. of Plastic Surgery
2
1
Ginecologic
Surgery
Tommaso Simoncini
Orthopedic
Surgery
Paolo D. Parchi
Ostetric and Ginecologic Division University of Pisa
1st Orthopedic Division University og Pisa
Medical Data (Rx, CT, MRI …)
Computer Aided Design
3D Virtual Model
Preoperative Virtual Planning
Computer Assisted Surgery
Rapid Prototyping
Preoperative Physical Planning
3D Solid Model
Surgical Guides
Design Custom Made Implants
Patient’s Specific Instrumentation
Plastic
Surgery
Subtotal and total nasal reconstruction: Use of nasal casts and
sculptures and 3D processing of CT images for surgical planning
• Nasal cast
• Carved nasal sculpture
• nasal model from 3D processing of CT images
Nasal Footprint
Cast - Template
Marcello Pantaloni - U.O.C. of Plastic Surgery
Flaps Design
Plastic
Surgery
Subtotal and total nasal reconstruction: Use of nasal casts and
sculptures and 3D processing of CT images for surgical planning
• Nasal cast
• Carved nasal sculpture
• nasal model from
processing of3DCT
images
CT 3D
Segmentation
Physical Model
3D Virtual Model
Marcello Pantaloni - U.O.C. of Plastic Surgery
Ginecologic
Surgery
3D MRI based Reconstruction System for computer simulation and
planning in uterine fibromatosis surgery
MRI Segmentation
3D Virtual Model
Corrispondence between
preoperative Plannig and
intraoperative Findings
Tommaso Simoncini - Ostetric and Ginecologic Division University of Pisa
Ginecologic
Surgery
3D MRI based Reconstruction System for computer simulation and
planning in uterine fibromatosis surgery
EFFECTS ON SURGICAL PROCEDURE:
OPEN SURGERY
Mini-invasive Surgery
OPEN
MINI-INVASIVE
Before using 3D
Models
6
12
After using 3D
Models
2
16
ISTERECTOMY vs MIOMECTOMY
ISTERECTOMY LPS MIOMECTOMY LPS
Before using 3D
Models
12
4
After using 3D
Models
7
9
Tommaso Simoncini - Ostetric and Ginecologic Division University of Pisa
Ginecologic
Surgery
3D MRI based Reconstruction System for computer simulation and
planning in uterine fibromatosis surgery
EFFECTS ON SURGICAL PROCEDURE:
SURGICAL TIME (miomectomy):
MIOMECTOMY
ULTRASOUND
47 ± 31 min
US + RMN + 3D Model
28 ± 11 min
INTRAOPERATIVE 3D Model CONSULTATION:
MIOMECTOMY
1-2 MIOMS
MIOMECTOMY
1,25 TIMES
Tommaso Simoncini - Ostetric and Ginecologic Division University of Pisa
> 2 MIOMS
3,75 TIMES
Orthopedic
Surgery
Patient specific approaches based on new technologies to plan and
to guide the surgical act in orthopedic surgery
Female 23 years old
shoutgun lesion at
the right hip
Preoperative Virtual Planning
Preoperative Physical Planning
Design Custom Made Implants
Preoperative Virtual Planning
Patient’s Specific Instrumentation
93% error < 1 mm
7% error 1-2 mm
University of Pisa PATENT
Paolo D. Parchi - 1st Orthopedic Division University og Pisa
Orthopedic
Surgery
Patient specific approaches based on new technologies to plan and
to guide the surgical act in orthopedic surgery
Preoperative Virtual Planning
Augmeted Reality Setup
Computer Assisted Surgery
In Vitro Test
CT scan Accuracy evaluation
Medium error of 1.48+/-0.81 mm
Paolo D. Parchi - 1st Orthopedic Division University og Pisa
Patient specific approaches based on new technologies to plan and to guide the
surgical act in plastic surgery, gynecologic surgery and orthopedic surgery
General Conclusions:
- Precise preoperative planning (before entering the surgical room the
surgeon kown the exact patient’s anatomy and each step of the surgical
procedure )
- Optimize the surgical act (changing the choice of the best surgical
technique for the patient)
- Guide the surgical act (reproducing the preoperative planning and
improving of the accuracy)
- Use of a Patient Specific Instrumentation (surgical guide) or Custom
made Implant